feature: Telepharmacy Improves Safety in Chemotherapy Preparation

The University of Kansas Hospital's
decision to implement telepharmacy
in the chemotherapy preparation
room in July 2007 has demonstrated
safety improvements.

Because there is no specific technology
available for chemotherapy preparation,
the Kansas City?based hospital
turned to ScriptPro Inc. In March 2007,
the hospital met with the company about
using their telepharmacy product in the
chemotherapy preparation area, and
ScriptPro modified the system to meet
the particular needs in the pharmacy
department.

"Given it didn't exist in a form to meet
our needs, it was a quick turnaround
from March to July," said Brian O'Neal,
MS, PharmD, assistant pharmacy director
at the hospital. "The system is easy to
use and the staff was trained in a week."

Preparation of chemotherapy medications
is one of the highest risk practices
in hospital pharmacies. Selecting the
right drug, drawing up the appropriate
volume, and injecting it into the intravenous
(IV) bag for the correct patient
are critical. A pharmacist is required to
oversee the process. Yet, with limited
pharmacist resources and the complications
of clean room operations, step-by-step
oversight is generally impossible.

Pharmacist oversight at the University
of Kansas and other hospitals involves
verifying the chemotherapy preparations
using the syringe pull-back method. In
the isolated chemotherapy preparation
room, a technician fills the syringe with
medication and injects it into the IV bag.
After the fact, the technician pulls back
the empty syringe to show the pharmacist
how much medication was injected.

The implementation of ScriptPro's
Telepharmacy improved the process for
the 508-bed hospital, which has 125 to
150 chemotherapy drugs go through the
pharmacy system a week. Working with
ScriptPro, the pharmacy administrators
placed a telepharmacy inspection camera
to take digital images at various
stages of the chemotherapy preparation
process in a biological safety cabinet in
the clean room. First, the technician
scans the bar code on the vial. Then, the
technician takes photos of the work
label, the vial, the fluids being used, and
finally, the syringe, before injection into
the bag. A pharmacist views the images
from a check station when verifying the
finished product.

"It [the system] allowed
us to get the safety benefit
we wanted while still allowing
the pharmacist to
see everything," he said.
Plus, it allows "us to keep
our clinical pharmacists on
the floor as part of a multidisciplinary
area."

Dr. O'Neal and his colleagues
authored "Innovations
in Chemotherapy
Preparation Safety: Use of
Telepharmacy and Barcode
Technology in the IV Admixture Area,"
which won a 2007 American Society of
Health-System Pharmacists Best Practice
Award in Health-System Pharmacy.

The paper documented the telepharmacy
process and the outcomes after 1
month of using the system. The process
demonstrated safety improvements in 4
main areas: